Retrograde tibial nailing of far distal tibia fractures : a biomechanical evaluation of double- versus triple-distal interlocking

Objectives Retrograde tibial nailing using the Distal Tibia Nail (DTN) is a novel surgical option in the treatment of distal tibial fracture. Its unique retrograde insertion increases the range of surgical options in far distal fractures of the tibia beyond the use of plating. The aim of this study was to assess the feasibility of the DTN for far distal tibia fractures where only double rather than triple-distal locking is possible due to fracture localisation and morphology. Methods Six Sawbones® were instrumented with a DTN and an AO/OTA 43-A3 fracture simulated. Samples were tested in two configurations: first with distal triple locking, second with double locking by removing one distal screw. Samples were subjected to compressive (350 N, 600 N) and torsional (± 8 Nm) loads. Stiffness construct and interfragmentary movement were quantified and compared between double and triple-locking configurations. Results The removal of one distal screw resulted in a 60–70% preservation of compressive stiffness, and 90% preservation of torsional stiffness for double locking compared to triple locking. Interfragmentary movement remained minimal for both compressive and torsional loading. Conclusions The DTN with a distal double locking can, therefore, be considered for far distal tibia fractures where nailing would be preferred over plating

Retrograde tibial nailing of far distal tibia fractures: a biomechanical evaluation of double- versus triple-distal interlocking

Greenfield J, Appelmann P, Wunderlich F, Mehler D, Rommens PM, Kuhn S. Retrograde tibial nailing of far distal tibia fractures: a biomechanical evaluation of double- versus triple-distal interlocking. European Journal of Trauma and Emergency Surgery. 2021.OBJECTIVES: Retrograde tibial nailing using the Distal Tibia Nail (DTN) is a novel surgical option in the treatment of distal tibial fracture. Its unique retrograde insertion increases the range of surgical options in far distal fractures of the tibia beyond the use of plating. The aim of this study was to assess the feasibility of the DTN for far distal tibia fractures where only double rather than triple-distal locking is possible due to fracture localisation and morphology.; METHODS: Six Sawbones were instrumented with a DTN and an AO/OTA 43-A3 fracture simulated. Samples were tested in two configurations: first with distal triple locking, second with double locking by removing one distal screw. Samples were subjected to compressive (350N, 600N) and torsional (±8 Nm) loads. Stiffness construct and interfragmentary movement were quantified and compared between double and triple-locking configurations.; RESULTS: The removal of one distal screw resulted in a 60-70% preservation of compressive stiffness, and 90% preservation of torsional stiffness for double locking compared to triple locking. Interfragmentary movement remained minimal for both compressive and torsional loading.; CONCLUSIONS: The DTN with a distal double locking can, therefore, be considered for far distal tibia fractures where nailing would be preferred over plating. © 2021. The Author(s)

A comparative biomechanical study of the Distal Tibia Nail against compression plating for the osteosynthesis of supramalleolar corrective osteotomies

Greenfield J, Appelmann P, Lafon Y, Bruyere-Garnier K, Rommens PM, Kuhn S. A comparative biomechanical study of the Distal Tibia Nail against compression plating for the osteosynthesis of supramalleolar corrective osteotomies. Scientific reports. 2021;11(1): 18834.The Distal Tibia Nail (DTN; Mizuho, Japan) has demonstrated higher biomechanical stiffness to locking plates in previous research for A3 distal tibia fractures. It is here investigated as a fixation option for supramalleolar corrective osteotomies (SMOT). Sixteen Sawbones tibiae were implanted with either a DTN (n=8) or Medial Distal Tibia Plate (MDTP; n=8) and a SMOT simulated. Two surgical outcome scenarios were envisaged: "best-case" representing an intact lateral cortex, and "worst-case" representing a fractured lateral cortex. All samples were subjected to compressive (350N, 700N) and torsional (±4 Nm,±8 Nm) testing. Samples were evaluated using calculated construct stiffness from force-displacement data, interfragmentary movement and Von Mises' strain distribution. The DTN demonstrated a greater compressive stiffness for the best-case surgical scenario, whereas the MDTP showed higher stiffness (p<0.05) for the worst-case surgical scenario. In torsional testing, the DTN proved more resistant to torsion in the worst-case surgical setup (p<0.05) for both±4 Nm and±8Nm. The equivalent stiffness of the DTN against the MDTP supports the use of this implant for SMOT fixation and should be considered as a treatment option particularly in patients presenting vascularisation problems where the MDTP is an inappropriate choice. © 2021. The Author(s)

¿Es la inmediación una condición de la condna penal?: un aspecto parcial de la lucha entre inquisición y composición

8th World Congress of Biomechanics, DUBLIN, IRELANDE, 08-/07/2018 - 12/07/2018Sample stiffness construct is often measured in studies relating to the mechanical behaviour of bone with/without implant. To improve the fit of the sample in the testing machine, and hence the reproducibility, researchers embed samples at their extremities in resin, in particular PolyMethyl MethAcrylate (PMMA)1. The aim of this work was to study the influence of resin-based embeddings on the total stiffness of the experimental setup of implanted tibiae used for fracture reduction research